Sleep and Rest
What are the 4 stages of sleep?
- N1 - stage 1 - Shortest - transitional stage
-N2 - stage 2- makes up 40-50% of a nights sleep time
-N3 - stage 3 - Deep sleep - 20% of sleep in young adults
-N4 - REM stage 4 - AKA active sleep because EEG pattern resembles that of walking hours. 20-25% of nights sleep
What is Insomnia?
A combination of poor sleep quality associated with an insufficient amount of sleep.
How does a nurse know that a client has pain?
the nurse asks the client if they have pain, pain is whatever the client says it is.
What is the antidote for opioid overdose?
Naloxone / Narcan
What are NSAIDs?
Nonsteroidal anti-inflammatory drugs
What is the max dose per day for acetaminophen?
4,000mg in a 24 hour period
What is acute pain?
up to 3 months
Define addiction
a neurobiologic disease characterized by the loss of control over drug use. compulsive use. and use despite of harm.
What is the Circadian Rhythm?
AKA circadian cycle
is a natural, internal process that regulates the sleep–wake cycle and repeats roughly every 24 hours.
What is Obstructive Sleep Apnea (OSA)?
the more common form that occurs when throat muscles relax and block the flow of air into the lungs.
Can be caused by anything that could narrow your airway such as obesity, large tonsils, or changes in your hormone levels can increase your risk for obstructive sleep apnea
an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
What is Nociceptive pain?
the classic pain process, usually seen as acute pain from surgery, injury, or active disease process.
What are some common side effects of opioid analgesics?
- dizziness
-sedation
-constipation / decreased bowel motility
- respiratory depression
-cardiac arrest
-hypotension
After administering Aspirin the nurse should evaluate the patient for what?
-s/s of bleeding (aspirin has anti-platelet activity)
-auditory and visual status
- renal function (if given more than 325mg)
- for GI irritation if not given with food
What is the difference between somatic and visceral pain?
Somatic pain - the type of pain you feel in your skin, muscles, joints, and bones. Tends to be localized and worsens with movement.
Visceral pain - occurs in out internal organs, is poorly localized, and often described as cramping, squeezing, or heaviness.
What is hyperalgesia?
An increased sensitivity to feeling pain and an extreme response to pain
What are some substances that disrupt sleep?
Alcohol and Caffeine
When a larger dose of opioid medications are required to produce the desired effects it is called what?
Tolerance
What are common side effects of opioid analgesic use?
-constipation
-decreased abdominal motility
-sedation
-dizziness
What are opioid analgesics typically used for?
moderate to severe pain and chronic pain
What is the max dose for Ibuprofen / Motrin
600 mg every 6 hr
recommended 400mg every 6 hr
What is a PCA pump?
Patient controlled analgesic
define dependance
when the body has become accustomed to the medications and when suddenly removed the body as a physiological response.
What hormone is released by the Pineal gland at night time and signals the brain that it is time to sleep?
Melatonin
What are parasomnias?
Activities that are normal when someone is awake but abnormal when someone is asleep.
- sleep walking or somnambulism
- bed wetting or enuresis
-night terrors which are most common with children
What are the 3 classifications of pain?
-Duration (acute versus chronic)
-mechanism (nociceptive, neuropathic, central or nociplastic)
-disease (cancer pain, sickle cell pain ect.)
What is nociplastic or central pain?
generalized as multifocal in nature, often not originating from any known injury.
Ex.) Fibromyalgia
What are two important things to keep in mind when administering Hydromorphone?
It is 7 times stronger than morphine
and
Naloxone / Narcan MUST be available
What is the antidote for Acetaminophen?
Acetylcystine (mucomyst) IV
What is Central Sleep Apnea?
which occurs when the brain doesn't send proper signals to the muscles that control breathing
What should a nurse evaluate for when administering pain medication?
-effectiveness of pain relief
-pain assessment with measurements (1-10 scale)
- the clients goal of pain management
What sleep stage is the lightest and what sleep stage is the deepest?
N1 is the lightest sleep stage
N3 is the deepest sleep stage
What is Cataplexy and how is it sometimes associated with nacrolepsy?
“Cataplexy is a sudden loss of muscle tone while awake that is sometimes associated with narcolepsy.”
Narcolepsy is A chronic sleep disorder that causes overwhelming daytime drowsiness.
What does the pain assessment PQRST stand for?
P- precipitating factor of pain
Q- quality of pain
R - Region / radiation of pain
S- Severity of pain
T - Timing
What are some indicators in inadequate pain management?
- client is asking for pain medication before the next dose is due
-inability to tolerate activity
-irritability / restlessness
-refusing to move or get out of bed
-increased activity
-inadequate sleep
What are some medications that are used for mild to moderate pain?
-NSAIDs
-ASA - asprin
- Acetaminophen
- ofirmev / Tylenol
- corticosteroids
Why does IV Ofirmev need vented tubing and what is it used for?
Because it comes in a glass bottle.
its used for moderate pain and moderate to severe pain with an opioid analgesic.
It is IV Tylenol
What is allodyna
"pain due to a stimulus that does not normally provoke pain." An example would be a light feather touch (that should only produce sensation), causing pain.
What is the COWS scale?
Clinical Opiate Withdrawal Scale
During what sleep phase are respirations irregular and thermoregulations impaired?
REM sleep
What are some factors that affect sleep quality?
What do we know about PCA pumps?
What is neuropathic pain?
often due to nerve damage from surgical procedures or disease process.
Ex.) diabetic neuropathy
Anticonvulsants and Antidepressants are also used to treat what kind of pain?
Neuropathic pain
What should a nurse keep in mind when giving Ketorolac / Toradol
- it should be used for less than 5 days
- increases risk for bleeding
- monitor renal functions
- most often given inpatient via IV
- NEVER give to a client with advanced renal disease or kidney transplant
What is the difference between Acute Insomnia and Chronic Insomnia?
Acute insomnia lasts from 1 night to a few weeks. Insomnia is chronic when it happens at least 3 nights a week for 3 months or more.
What are some nursing interventions for pain medication?
-assess client prior to giving medication
-evaluate effectiveness of medication
-monitor vital signs
-educate patient and family about potential side effects